Loud's fame came with An American Family, a documentary of his family's life, which was broadcast in the U.S. on PBS in 1973, drawing 10 million viewers and causing considerable controversy. The show was based in Santa Barbara, California.

Loud moved to New York City, driven by his obsession with The Velvet Underground and the Warhol scene. He became a regular at Max's Kansas City and attended Charles Ludlam productions at La Mama, with luminaries such as Jackie Curtis (who later became a close Loud family friend) and Holly Woodlawn. Shortly after the series ended, Loud appeared on The Dick Cavett Show, performing with a working version of what would later become the band "Mumps" (which at that point included his siblings Delilah, Michelle and Kevin in the line-up), under the name "Loud". He stated at the time that he thought the filmmakers had intentionally edited the series to make him seem obnoxious and grating.

Loud became a gay icon by having his homosexuality revealed to a national audience during the course of the documentary.[2] His sexual orientation became a topic of national controversy and media scrutiny after several appearances on Dick Cavett and other talk shows, but the positive and grateful feedback from the gay community led Loud to embrace this role with passion and flamboyant, often self-deprecating wit.[citation needed]

Loud wrote a monthly column in the influential Rock Scene magazine, where he reported on his favorite artists and covered unlikely junkets, such as a brief tour with Jim Dandy Mangrum from Black Oak Arkansas. Rock Scene was an early supporter of glam and the punk scene.

When Loud retired from music, he became a noted columnist for several magazines, including The Advocate, Details, Interview, and Creem. Through journalism and sheer force of personality, Loud remained active in many cultural scenes throughout most of his adult life, giving occasional lectures on the impact of An American Family on American society at colleges around the country. He was present at the Andy Warhol Museum in Pittsburgh when his teenage letters to Andy were officially entered into the Andy Warhol archive.

The Loud family was kept in the public eye through two televised PBS updates, both filmed by the original Academy Award winning team of Alan and Susan Raymond.[4] The last, called Lance Loud! A Death in An American Family, was a poignant depiction of Loud's physical decline, from a 20-year addiction to crystal meth and complications from HIV. It was shown on PBS in January 2003.[4] Subsequent to the showing of A Death in An American Family, Pat and Bill Loud moved back in together, granting one of their oldest son's last wishes. They live very close to three of their four surviving children in California, with the exception of Kevin, who lives out-of-state with his family.

In 2001, Loud entered the Carl Bean hospice in Los Angeles, California, suffering from HIV and hepatitis C. Realizing he was dying, Loud called the Raymonds back to film again, expressing dissatisfaction with the way An American Family ended and how the family members were portrayed in it. His wish was that the Louds be portrayed as the family Loud knew them to be. While in hospice care, he wrote his final article, "Musings on Mortality".[5]

On December 22, 2001, Lance Loud died of liver failure as a result of hepatitis C and a co-infection with HIV. He was 50 years old.[6]

In 2010 HBO Films announced that it was making Cinema Verite, a film about the making of An American Family. Thomas Dekker was cast to play Loud.[7] The film had its debut showing on HBO on April 23, 2011.[8]

In 2012, Lance's mother authored a book about his life called "Lance Out Loud"; it was edited by Christopher Makos, a longtime friend of Lance, and published by Glitterati Incorporated.

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In his last few days, on having injected crystal meth for 20 years: "I was a bit of a prick."

In his final appearance on camera in the 2003 documentary Lance Loud: A Death in An American Family, as mother Pat holds him in her arms, he states, "When Louds love, they love long and deep: about six feet deep."

Narrating over footage of himself at the Chelsea in Episode 2 of An American Family: "Living in New York, I've become more and more aware that there are other things. If someone gave me a ticket it would just be another excuse and it would be so easy to just go back there and go up to Isla Vista Beach and just sit there all summer long, see my old friends and all my old enemies. Seeing enemies is much more interesting than seeing friends ... and I have so many enemies in Santa Barbara. Always, always interesting. But I think that ... you know, New York has so many things that really do interest me or that could interest me that for ... for my own good, I think I'll just have to stay. Even if I really don't want to. In fact I guess I really don't. It is so much easier just to go home. I could get a little job and make everyone happy on a day to day type basis and get a little money and live by myself in my own apartment or something ... but I don't think that's what I really want to do. I've always felt that, to be dedicated to life, you have to be really passionate, and so I never really think anything is just ok, I either love something or I just hate it forever, to death."

Mumps: How I Saved the World (Sympathy for the Music Industry, 2005), an anthology of recordings, with a DVD of live performances. Loud is the lead singer and co-songwriter (with Kristian Hoffman) for this popular CBGB era NYC headlining pop/punk outfit.